Tortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdf

GerardJ.Tortora / BryanDerrickson
&
principles of
anatomy physiology
14th Edition

Principles of
ANATOMY &
PHYSIOLOGY
Gerard J. Tortora
Bergen Community College
Bryan Derrickson
Valencia College
14th Edition

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10 9 8 7 6 5 4 3 2 1

ABOUT THE AUTHORS
Jerry Tortora is Professor of Biology and former Biology Coordinator at Bergen Community College in
Paramus, New Jersey, where he teaches human anatomy and physiology as well as microbiology. He received
his bachelor’s degree in biology from Fairleigh Dickinson University and his master’s degree in science
education from Montclair State College. He is a member of many professional organizations, including
the Human Anatomy and Physiology Society (HAPS), the American Society of Microbiology (ASM), the
American Association for the Advancement of Science (AAAS), the National Education Association (NEA),
and the Metropolitan Association of College and University Biologists (MACUB).
Above all, Jerry is devoted to his students and their aspirations. In recognition of this commitment, Jerry
was the recipient of MACUB’s 1992 President’s Memorial Award. In 1996, he received a National Institute
for Staff and Organizational Development (NISOD) excellence award from the University of Texas and was
selected to represent Bergen Community College in a campaign to increase awareness of the contributions of
community colleges to higher education.
Jerry is the author of several best-selling science textbooks and laboratory manuals, a calling that often requires an additional
40 hours per week beyond his teaching responsibilities. Nevertheless, he still makes time for four or five weekly aerobic workouts
that include biking and running. He also enjoys attending college basketball and professional hockey games and performances at the
Metropolitan Opera House.
Courtesy
of
Heidi
Chung
To Reverend Dr. James F. Tortora, my brother, my friend, and my role model.
His life of dedication has inspired me in so many ways, both personally and professionally,
and I honor him and pay tribute to him with this dedication. G.J.T.
Courtesy
of
Gerard
J.
Tortora
Bryan Derrickson is Professor of Biology at Valencia College in Orlando, Florida, where he teaches
human anatomy and physiology as well as general biology and human sexuality. He received his bachelor’s
degree in biology from Morehouse College and his Ph.D. in cell biology from Duke University. Bryan’s
study at Duke was in the Physiology Division within the Department of Cell Biology, so while his degree
is in cell biology, his training focused on physiology. At Valencia, he frequently serves on faculty hiring
committees. He has served as a member of the Faculty Senate, which is the governing body of the college,
and as a member of the Faculty Academy Committee (now called the Teaching and Learning Academy),
which sets the standards for the acquisition of tenure by faculty members. Nationally, he is a member of
the Human Anatomy and Physiology Society (HAPS) and the National Association of Biology Teachers
(NABT). Bryan has always wanted to teach. Inspired by several biology professors while in college, he
decided to pursue physiology with an eye to teaching at the college level. He is completely dedicated to the success of his students.
He particularly enjoys the challenges of his diverse student population, in terms of their age, ethnicity, and academic ability, and finds
being able to reach all of them, despite their differences, a rewarding experience. His students continually recognize Bryan’s efforts and
care by nominating him for a campus award known as the “Valencia Professor Who Makes Valencia a Better Place to Start.” Bryan
has received this award three times.
To my family: Rosalind, Hurley, Cherie, and Robb.
Your support and motivation have been invaluable to me. B.H.D.
Courtesy
of
Bryan
Derrickson
iii

PREFACE
An anatomy and physiology course can be the gateway to a gratifying career in a host of health-related
professions. It can also be an incredible challenge. Principles of Anatomy and Physiology, 14th
edition continues to offer a balanced presentation of content under the umbrella of our primary and
unifying theme of homeostasis, supported by relevant discussions of disruptions to homeostasis. Through
years of collaboration with students and instructors alike, this new edition of the text—integrated with
WileyPLUS with ORION—brings together deep experience and modern innovation to provide solutions
for students’ greatest challenges.
We have designed the organization and flow of content within these pages to provide students with
an accurate, clearly written, and expertly illustrated presentation of the structure and function of
the human body. We are also cognizant of the fact that the teaching and learning environment has
changed significantly to rely more heavily on the ability to access the rich content in this printed text
in a variety of digital ways, anytime and anywhere. We are pleased that this 14th edition meets these
changing standards and offers dynamic and engaging choices to make this course more rewarding
and fruitful. Students can start here, and armed with the knowledge they gain through a professor’s
guidance using these materials, be ready to go anywhere with their careers.
New for This Edition
The 14th edition of Principles of Anatomy and Physiology has been updated throughout, paying
careful attention to include the most current medical terms in use (based on Terminologia Anatomica)
and including an enhanced glossary. The design has been refreshed to ensure that the content is
clearly presented and easy to access. Clinical Connections that help students understand the relevance
of anatomical structures and functions have been updated throughout and in some cases are now
placed alongside related illustrations to strengthen these connections for students.
The all-important illustrations that support this most visual of sciences have been scrutinized and
revised as needed throughout. Nearly every chapter of the text has a new or revised illustration or
photograph.
iv
Superior view with atria removed: pulmonary and aortic
valves closed, bicuspid and tricuspid valves open
Superior view with atria removed: pulmonary and aortic
valves open, bicuspid and tricuspid valves closed
PULMONARY
VALVE (closed)
AORTIC
VALVE
(closed)
Right coronary
artery
Left coronary
artery
TRICUSPID
VALVE
(open)
BICUSPID
VALVE
(open)
ANTERIOR
POSTERIOR
PULMONARY
VALVE (open)
AORTIC
VALVE
(open)
TRICUSPID
VALVE
(closed)
BICUSPID
VALVE
(closed)
POSTERIOR
ANTERIOR

Anterior view
Frontal section through ethmoid bone in skull
Vomer
Maxillary
sinus
Left
orbit
Crista galli
Frontal
sinus
Perpendicular
plate
Superior nasal
concha
Superior nasal
meatus
Middle nasal
meatus
Maxilla
Oral cavity
Middle nasal
concha
Inferior nasal
concha
Inferior nasal
meatus
Cell body
Axon
Dendrites
Axosomatic
Axoaxonic
Axodendritic
Knee joint
v
x8000
SEM x4000
SEM x2700
SEM
RIGHT LATERAL LOBE OF THYROID GLAND
LEFT LATERAL LOBE OF THYROID GLAND
ISTHMUS OF THYROID GLAND
Right lung
Thyroid cartilage of larynx
Cricoid cartilage of larynx
Trachea
Arch of aorta
Optic nerve
Periorbital fat
Brain
Superior nasal concha
Superior nasal meatus
Middle nasal concha
Middle nasal meatus
Inferior nasal meatus
Maxillary sinus
Inferior nasal concha
Hard palate
Tongue
Vomer
Perpendicular
plate of ethmoid
Nasal septum:
Ethmoidal cells
Frontal section showing conchae and meatuses
Extension
Extension
Extension
Flexion
Flexion
Flexion
Flexion
Extension
Hyperextension
Hyperextension
Hyperextension
Wrist joint
Atlanto-occipital and cervical
intervertebral joints
Shoulder joint Elbow joint
Intervertebral joints
Extension
Flexion
Flexion
Extension
Hyperextension
Hip joint
Lateral
flexion

vi
Enhancing our emphasis on the importance of homeostasis and the mechanisms that support it, we have re-
designed the illustrations describing feedback diagrams throughout the text. Introduced in the first chapter, the
distinctive design helps students recognize the key components of a feedback cycle, whether studying the control
of blood pressure, regulation of breathing, regulation of glomerular filtration
rate, or a host of other functions involving negative or positive feedback. To
aid visual learners, color is used consistently—green for a controlled condition,
blue for receptors, purple for the control center, and red for effectors.
STIMULUS
CONTROLLED CONDITION
Blood pressure
RESPONSE
A decrease in heart rate
and the dilation (widening)
of blood vessels cause
blood pressure to decrease
RECEPTORS
Baroreceptors
in certain
blood vessels
CONTROL CENTER
Brain
EFFECTORS
Heart
Blood
vessels
Disrupts homeostasis
by increasing
Return to
homeostasis when
the response brings
blood pressure
back to normal
–
Output
Input Nerve impulses
Nerve impulses
Figure 1.3 Homeostatic regulation of blood pressure by
a negative feedback system. The broken return arrow with a
negative sign surrounded by a circle symbolizes negative feedback.
If the response reverses the stimulus, a system is
operating by negative feedback.
What would happen to heart rate if some stimulus
caused blood pressure to decrease? Would this occur by
way of positive or negative feedback?
manBody.indd Page 10 7/11/13 11:08 AM f-481 /204/WB00924/9781118345009/ch01/text_s
Figure 21.14 Negative feedback regulation of blood
pressure via baroreceptor reflexes.
When blood pressure decreases, heart rate increases.
Does this negative feedback cycle represent the changes
that occur when you lie down or when you stand up?
STIMULUS
RESPONSE
RECEPTORS
CONTROL CENTERS
EFFECTORS
Disrupts homeostasis
by decreasing
–
Output
Input
Blood pressure
Baroreceptors
in carotid sinus
and arch of aorta
Stretch less, which decreases
rate of nerve impulses
CV center in
medulla oblongata
Adrenal
medulla
Heart
Blood
vessels
Return to homeostasis
when increased
cardiac output and
increased vascular
resistance bring
blood pressure
back to normal
Increased blood pressure
Increased
sympathetic,
decreased para-
sympathetic
stimulation
Increased secretion
of epinephrine and
norepinephrine
from adrenal medulla
Increased stroke
volume and heart rate
lead to increased
cardiac output (CO)
Constriction of blood
vessels increases
systemic vascular
resistance (SVR)
c21TheCardiovascularSystemBloodVesselsAndHemodynamics.indd Page 747 9/16/13 8:35 AM f-481

INTEGUMENTARY
SYSTEM
Androgens stimulate growth of axillary
and pubic hair and activation of
sebaceous glands
Excess melanocyte-stimulating hormone
(MSH) causes darkening of skin
LYMPHATIC SYSTEM
and IMMUNITY
Glucocorticoids such as cortisol depress
inflammation and immune responses
Thymic hormones promote maturation of
T cells (a type of white blood cell)
RESPIRATORY
SYSTEM
Epinephrine and norepinephrine dilate
(widen) airways during exercise and other
stresses
Erythropoietin regulates amount of
oxygen carried in blood by adjusting
number of red blood cells
DIGESTIVE
SYSTEM
Epinephrine and norepinephrine depress
activity of the digestive system
Gastrin, cholecystokinin, secretin, and
glucose-dependent insulinotropic
peptide (GIP) help regulate digestion
Calcitriol promotes absorption of dietary
calcium
Leptin suppresses appetite
URINARY
SYSTEM
ADH, aldosterone, and atrial natriuretic
peptide (ANP) adjust the rate of loss of
water and ions in the urine, thereby
regulating blood volume and ion content
of the blood
REPRODUCTIVE
SYSTEMS
Hypothalamic releasing and inhibiting
hormones, follicle-stimulating hormone
(FSH), and luteinizing hormone (LH)
regulate development, growth, and
secretions of the gonads (ovaries and
testes)
Estrogens and testosterone contribute to
development of oocytes and sperm and
stimulate development of secondary sex
characteristics
Prolactin promotes milk secretion in
mammary glands
Oxytocin causes contraction of the uterus
and ejection of milk from the mammary
glands
MUSCULAR
SYSTEM
Epinephrine and norepinephrine help
increase blood flow to exercising muscle
PTH maintains proper level of Ca2+
,
needed for muscle contraction
Glucagon, insulin, and other hormones
regulate metabolism in muscle fibers
hGH, IGFs, and thyroid hormones help
maintain muscle mass
NERVOUS
SYSTEM
Several hormones, especially thyroid
hormones, insulin, and growth hormone,
influence growth and development of the
nervous system
PTH maintains proper level of Ca2+
,
needed for generation and conduction of
nerve impulses
CARDIOVASCULAR
SYSTEM
Erythropoietin (EPO) promotes formation
of red blood cells
Aldosterone and antidiuretic hormone
(ADH) increase blood volume
Epinephrine and norepinephrine increase
heart rate and force of contraction
Several hormones elevate blood pressure
during exercise and other stresses
SKELETAL
SYSTEM
Human growth hormone (hGH) and
insulinlike growth factors (IGFs) stimulate
bone growth
Estrogens cause closure of the epiphyseal
plates at the end of puberty and help
maintain bone mass in adults
Parathyroid hormone (PTH) and calcitonin
regulate levels of calcium and other
minerals in bone matrix and blood
Thyroid hormones are needed for normal
development and growth of the skeleton
CONTRIBUTIONS OF
THE ENDOCRINE SYSTEM
FOR ALL BODY SYSTEMS
Together with the nervous system, circulating
and local hormones of the endocrine system
regulate activity and growth of target cells
throughout the body
Several hormones regulate metabolism,
uptake of glucose, and molecules used for
ATP production by body cells
FOCUS on HOMEOSTASIS
We are most excited about the enhanced digital experience now available with the 14th edition of this
text. WileyPLUS now includes a powerful new adaptive learning component called ORION that allows
students to take charge of their study time in ways they have not previously experienced and prepares
them for more meaningful classroom and laboratory interactions. WileyPLUS itself has been refreshed
with a new design that allows easier discoverability and access to the rich resources including new 3-D
animations, Interactions, Muscles in Motion, Real Anatomy, Anatomy Drill and Practice, and PowerPhys.
New for the 14th edition is a digital alternative called All Access Pack for Principles of Anatomy
and Physiology, 14th edition. This choice offers you a full e-text to download and keep, full access to
WileyPLUS, and a Study Resource Guide to use as a basis for taking notes in class and studying. It provides
you with everything you need for your course, anytime, anywhere, on any device.
vii
In addition, following the
chapter or chapters covering
each body system, a page
is devoted to fostering
understanding of how each
system contributes to overall
homeostasis through its
interaction with other body
systems. These Focus on
Homeostasis pages have
been redesigned for a more
effective presentation of this
summary material.

WileyPLUS with ORION
WileyPLUS with ORION helps students learn by learning
about them.
ORION is a new addition to WileyPLUS that provides students with a personal,
adaptive learning experience to help them build their proficiency on topics and use
study time most efficiently.
WileyPLUS with ORION is great as:
• an adaptive pre-lecture tool that assesses your students’ conceptual knowledge so
they come to class better prepared,
• a personalized study guide that helps students understand both strengths and
areas where they need to invest more time, especially in preparation for quizzes and
exams.
Unique to ORION, students begin by taking a quick diagnostic for any chapter. This will determine
each student’s baseline proficiency on each topic in the chapter. Students see their individual
diagnostic report to help them decide what to do next with the help of ORION’s recommendations.
For each topic, students can either Study or Practice. Study directs the student to the specific topic
they choose in WileyPLUS, where they can read from the e-textbook and use the variety of relevant
resources available there.
Students can also practice, using questions and feedback powered by ORION’s adaptive learning
engine. Based on the results of their diagnostic and ongoing practice, ORION will present students
with questions appropriate for their current level of understanding and will continuously adapt to
each student, helping them build their proficiency.
ORION includes a number of reports and ongoing recommendations for students to help them
maintain their proficiency over time for each topic. Students can easily access ORION from
multiple places within WileyPLUS. It does not require any additional registration, and there will
not be any additional charge for students using this adaptive learning system.
MAINTAIN
PRACTICE
BEGIN
viii

Resources in WileyPLUS That Power Success
The WileyPLUS user experience will be more satisfying than ever for both students and professors, thanks to
dynamic new content and a more effective design. A visual ribbon immediately links students to powerful course-level
programs. Navigation to specific con-
tent within these programs matched
to chapters or learning objectives
is greatly enhanced in the new
WileyPLUS design, as well.
New 3-D Physiology Dramatic, new 3-D animations of some of the toughest topics that students encoun-
ter in anatomy and physiology are fully integrated into WileyPLUS.
Topics include Active and Passive Transport Mechanisms; Sliding Fila-
ment Mechanism; Membrane Potentials; Synapses and Neurotrans-
mitter Action; Hormone Function and Actions; Cardiac Conduction;
Cardiac Cycle; Antibodies, Antigens, T Cells, and B Cells; Nephron
Physiology; and Countercurrent Mechanism. Assessment questions are
available as an assignment for each animation.
Interactions: Exploring the Functions
of the Human Body 3.0
Thomas Lancraft and Frances Frierson
Interactions 3.0 is the most complete program of interactive
animations and activities available for anatomy and physiology.
A series of modules encompassing all body systems focuses on a
review of anatomy (50 anatomy overviews), the examination of
physiological processes using animations (75 multipart animations) and interactive exercises (122 exercises and
54 concept maps), and clinical correlations to enhance student understanding (25 animated and interactive case
studies). New assignments include gradable questions linked to all animations and are now completely gradable
through WileyPLUS.
Muscles in Motion Included in Muscles in Motion are animations of seven major joints—scapula, shoulder,
elbow, wrist, hip, knee, and ankle. All are rendered in 3-D format from multiple camera angles. The program begins
with an introductory animation of a baseball bat swing that uses muscles and actions involving all of these joints. Each
individual joint is then explored through three distinct sections: Skeletal Anatomy, which presents
the anatomical structures related to the joint; Muscles and Movements, which introduces each
muscle involved, highlighting the
origin, insertion, and movements;
and Muscles in Motion, which
isolates the movements of the
baseball swing that applies to the
specific joint being reviewed.
ix

x
Mark Nielsen and Shawn Miller, University of Utah
Real Anatomy is 3-D imaging software that allows you to dissect through multiple
layers of a three-dimensional real human body to study and learn the anatomical
structures of all body systems.
Real Anatomy 2.0
• Now available on the Web, accessible by
iPad and Android tablets.
• All possible highlighted structures on an
image are now accessible via a drop-down
list and are searchable.
NEW to Real Anatomy 2.0
• New crumb trail navigation shows context of
system, image, and structure.
• Fully integrated into WileyPLUS for Anatomy.
• Dissect through up to 40 layers of the body
and discover the relationships of the structures to
the whole.
• Rotate the body as well as major organs to view the image
from multiple perspectives.
• Use a built-in zoom feature to get a closer look at detail.
• A unique approach to highlighting and labeling structures
does not obscure the real anatomy in view.
NOW WEB
ENABLED

• Snapshots of any image can
be saved for use in PowerPoints,
quizzes, or handouts.
• Related images provide
multiple views of structures
being studied.
• View histology micro-
graphs at varied levels of
magnification with the virtual microscope.
Anatomy Drill and Practice
Anatomy Drill and Practice lets you test your knowl-
edge of structures with simple to use drag-and-drop
labeling exercises, or fill-in-the-blank labeling. You
can drill and practice on these activities using illustra-
tions from the text, cadaver photographs, histology
micrographs, or anatomical models. All illustrations
are available as gradable assessment questions within
WileyPLUS.
xi
• Audio pronunciation of all
labeled structures is readily
available.

Photographic Atlas of Human Anatomy, 1st edition
Mark Nielsen and Shawn Miller, University of Utah
This beautiful atlas, filled with outstanding photographs of meticulously executed dissections
of the human body, is a strong teaching and learning solution, not just a catalog of photo-
graphs. Organized around body systems, each chapter of this exciting new resource includes a
narrative overview of the body system followed by detailed photographs that accurately and
realistically represent the anatomical structures. Histology is included. Photographic Atlas of
Human Anatomy will work well in your laboratories, as a study companion to your textbook,
and as a print companion to Real Anatomy 2.0.
xii
PowerPhys 3.0
PowerPhys 3.0 is physiological simulation software that allows
students to explore physiology principles through 13 self-contained
activities. PowerPhys 3.0 is now tablet-enabled for use on mobile
devices. Three new modules are included: Hematocrit and Hemoglobin
Concentration and Blood Typing; Acid–Base Balance; and Effect of
Dietary Fiber on Transit Time and Bile.
Each activity follows the scientific method, containing objectives
with illustrated and animated review material, pre-lab quizzes,
pre-lab reports (including predictions and
variables), data collection and analysis, and
a full lab report with discussion and applica-
tion questions. Experiments contain real data
that are randomly generated, allowing users
to experiment multiple times but still arrive
at the same conclusions. These activities focus
on core physiological concepts and reinforce
techniques experienced in the laboratory.
Laboratory Manual for Anatomy and Physiology, 5th edition
Connie Allen and Valerie Harper
Newly revised, the Laboratory Manual for Anatomy and Physiology, 5th edition with WileyPLUS
engages your students in active learning and focuses on the most important concepts in
A&P. Exercises reflect the multiple ways in which students learn and provide guidance for
anatomical exploration and application of critical thinking to analyzing physiological pro-
cesses. A concise narrative, self-contained exercises that include a wide variety of activities
and question types, and two types of lab reports for each exercise keep students focused
on the task at hand. Depending on your needs, a newly revised Cat Dissection Manual or
Fetal Pig Dissection Manual accompanies the main text. Within WileyPLUS you will find
12 new Biopac Laboratory Guide exercises as well as exceptional new dissection videos
of the cat and fetal pig. Each lab text comes with access to PowerPhys 3.0.
Laboratory Support

ACKNOWLEDGMENTS
We wish to especially thank several academic colleagues for their
helpful contributions to this edition. We are very grateful to our
colleagues who have reviewed the manuscript, participated in focus
groups and meetings, or offered suggestions for improvement.
Most importantly, we thank those who have contributed to the
creation and integration of this text with WileyPLUS with ORION.
The improvements and enhancements for this edition are possible
in large part because of the expertise and input of the following
people:
Matthew Abbott, Des Moines Area Community College
Ayanna Alexander-Street, Lehman College of New York
Donna Balding, Macon State College
Celina Bellanceau, Florida Southern College
Dena Berg, Tarrant County College
Betsy Brantley, Valencia College
Susan Burgoon, Armadillo College
Steven Burnett, Clayton State University
Heidi Bustamante, University of Colorado Boulder
Anthony Contento, Colorado State University
Liz Csikar, Mesa Community College
Kent Davis, Brigham Young University Idaho
Kathryn Durham, Lorain County Community College
Kaushik Dutta, University of New England
Karen Eastman, Chattanooga State Community College
John Erickson, Ivy Tech Community College of Indiana
John Fishback, Ozark Tech Community College
Linda Flora, Delaware County Community College
Aaron Fried, Mohawk Valley Community College
Sophia Garcia, Tarrant County College
Lynn Gargan, Tarrant County College
Caroline Garrison, Carroll Community College
Lena Garrison, Carroll Community College
Geoffrey Goellner, Minnesota State University Mankato
Harold Grau, Christopher Newport University
DJ Hennager, Kirkwood Community College
Lisa Hight, Baptist College of Health Sciences
Mark Hubley, Prince George’s Community College
Jason Hunt, Brigham Young University Idaho
Alexander Imholtz, Prince George’s Community College
Michelle Kettler, University of Wisconsin
Cynthia Kincer, Wytheville Community College
Tom Lancraft, St. Petersburg College
Claire Leonard, William Paterson University
Jerri Lindsey, Tarrant County College
Alice McAfee, University of Toledo
Shannon Meadows, Roane State Community College
Shawn Miller, University of Utah
Erin Morrey, Georgia Perimeter College
Qian Moss, Des Moines Area Community College
Mark Nielsen, University of Utah
Margaret Ott, Tyler Junior College
Eileen Preseton, Tarrant County College
Saeed Rahmanian, Roane State Community College
Sandra Reznik, St. John’s University
Laura Ritt, Burlington Community College
Amanda Rosenzweig, Delgado Community College
Sandy Stewart, Vincennes University
Jane Torrie, Tarrant County College
Maureen Tubbiola, St. Cloud State
Jamie Weiss, William Paterson University
Finally, our hats are off to everyone at Wiley. We enjoy col-
laborating with this enthusiastic, dedicated, and talented team of
publishing professionals. Our thanks to the entire team: Bonnie
Roesch, Executive Editor; Karen Trost, Developmental Editor;
Lauren Elfers, Associate Editor; Brittany Cheetham, Assistant
Editor; Grace Bagley, Editorial Assistant; Erin Ault, Senior
Production Editor; Mary Ann Price, Senior Photo Editor; Claudia
Volano, Illustration Editor; Madelyn Lesure, Senior Designer;
Linda Muriello, Senior Product Designer; and Maria Guarascio,
Marketing Manager.
GERARD J. TORTORA
Department of Science and Health, S229
Bergen Community College
400 Paramus Road
Paramus, NJ 07652
gjtauthor01@optonline.net
BRYAN DERRICKSON
Department of Science, PO Box 3028
Valencia College
Orlando, FL 32802
bderrickson@valenciacollege.edu
xiii

xiv
BRIEF CONTENTS
1 AN INTRODUCTION TO THE HUMAN BODY 1
2 THE CHEMICAL LEVEL OF ORGANIZATION 27
3 THE CELLULAR LEVEL OF ORGANIZATION 59
4 THE TISSUE LEVEL OF ORGANIZATION 106
5 THE INTEGUMENTARY SYSTEM 142
6 THE SKELETAL SYSTEM: BONE TISSUE 169
7 THE SKELETAL SYSTEM: THE AXIAL SKELETON 192
8 THE SKELETAL SYSTEM: THE APPENDICULAR SKELETON 231
9 JOINTS 258
10 MUSCULAR TISSUE 291
11 THE MUSCULAR SYSTEM 328
12 NERVOUS TISSUE 399
13 THE SPINAL CORD AND SPINAL NERVES 442
14 THE BRAIN AND CRANIAL NERVES 473
15 THE AUTONOMIC NERVOUS SYSTEM 523
16 SENSORY, MOTOR, AND INTEGRATIVE SYSTEMS 546
17 THE SPECIAL SENSES 572
18 THE ENDOCRINE SYSTEM 615
19 THE CARDIOVASCULAR SYSTEM: THE BLOOD 661
20 THE CARDIOVASCULAR SYSTEM: THE HEART 688
21 THE CARDIOVASCULAR SYSTEM: BLOOD VESSELS AND HEMODYNAMICS 729
22 THE LYMPHATIC SYSTEM AND IMMUNITY 799
23 THE RESPIRATORY SYSTEM 840
24 THE DIGESTIVE SYSTEM 886
25 METABOLISM AND NUTRITION 940
26 THE URINARY SYSTEM 979
27 FLUID, ELECTROLYTE, AND ACID–BASE HOMEOSTASIS 1023
28 THE REPRODUCTIVE SYSTEMS 1041
29 DEVELOPMENT AND INHERITANCE 1089
APPENDIX A: MEASUREMENTS A-1 APPENDIX B: PERIODIC TABLE B-3 APPENDIX C: NORMAL
VALUES FOR SELECTED BLOOD TESTS C-4 APPENDIX D: NORMAL VALUES FOR SELECTED URINE
TESTS D-6 APPENDIX E: ANSWERS E-8 GLOSSARY G-1 CREDITS C-1 INDEX I-1

xv
CONTENTS
1 AN INTRODUCTION TO THE HUMAN
BODY 1
1.1 Anatomy and Physiology Defined 2
1.2 Levels of Structural Organization and Body Systems 2
1.3 Characteristics of the Living Human Organism 5
Basic Life Processes 5
1.4 Homeostasis 8
Homeostasis and Body Fluids 8
Control of Homeostasis 9
Homeostatic Imbalances 11
1.5 Basic Anatomical Terminology 12
Body Positions 12
Regional Names 12
Directional Terms 13
Planes and Sections 16
Body Cavities 17
Abdominopelvic Regions and Quadrants 19
1.6 Medical Imaging 20
Chapter Review and Resource Summary 24 / Critical Thinking
Questions 26 / Answers to Figure Questions 26
2 THE CHEMICAL LEVEL OF
ORGANIZATION 27
2.1 How Matter Is Organized 28
Chemical Elements 28
Structure of Atoms 28
Atomic Number and Mass Number 29
Atomic Mass 31
Ions, Molecules, and Compounds 31
2.2 Chemical Bonds 31
Ionic Bonds 32
Covalent Bonds 33
Hydrogen Bonds 34
2.3 Chemical Reactions 35
Forms of Energy and Chemical Reactions 35
Energy Transfer in Chemical Reactions 35
Types of Chemical Reactions 36
2.4 Inorganic Compounds and Solutions 38
Water 38
Solutions, Colloids, and Suspensions 39
Inorganic Acids, Bases, and Salts 40
Acid–Base Balance: The Concept of pH 40
Maintaining pH: Buffer Systems 41
2.5 Organic Compounds 42
Carbon and Its Functional Groups 42
Carbohydrates 43
Lipids 45
Proteins 48
Nucleic Acids: Deoxyribonucleic Acid (DNA) and Ribonucleic
Acid (RNA) 52
Adenosine Triphosphate 55
3 THE CELLULAR LEVEL OF
ORGANIZATION 59
3.1 Parts of a Cell 60
3.2 The Plasma Membrane 61
Structure of the Plasma Membrane 61
Functions of Membrane Proteins 62
Membrane Fluidity 62
Membrane Permeability 63
Gradients across the Plasma Membrane 64
3.3 Transport across the Plasma Membrane 64
Passive Processes 64
Active Processes 69
3.4 Cytoplasm 73
Cytosol 73
Organelles 76
3.5 Nucleus 84
3.6 Protein Synthesis 87
Transcription 87
Translation 89
3.7 Cell Division 91
Somatic Cell Division 91
Control of Cell Destiny 94
Reproductive Cell Division 95
3.8 Cellular Diversity 98
3.9 Aging and Cells 98
Medical Terminology 101 / Chapter Review and Resource
Summary 101 / Critical Thinking Questions 104 / Answers to
Figure Questions 104
4 THE TISSUE LEVEL OF
ORGANIZATION 106
4.1 Types of Tissues 107
4.2 Cell Junctions 107
Tight Junctions 108
Adherens Junctions 108

xvi CONTENTS
Desmosomes 109
Hemidesmosomes 109
Gap Junctions 109
4.3 Comparison between Epithelial and Connective
Tissues 109
4.4 Epithelial Tissue 110
Classification of Epithelial Tissue 111
Covering and Lining Epithelium 112
Glandular Epithelium 118
4.5 Connective Tissue 121
General Features of Connective Tissue 121
Connective Tissue Cells 121
Connective Tissue Extracellular Matrix 122
Classification of Connective Tissue 123
Embryonic Connective Tissue 123
Mature Connective Tissue 123
4.6 Membranes 131
Epithelial Membranes 132
Synovial Membranes 134
4.7 Muscular Tissue 134
4.8 Nervous Tissue 136
4.9 Excitable Cells 136
4.10 Tissue Repair: Restoring Homeostasis 136
4.11 Aging and Tissues 138
5 THE INTEGUMENTARY SYSTEM 142
5.1 Structure of the Skin 143
Epidermis 144
Keratinization and Growth of the Epidermis 147
Dermis 147
The Structural Basis of Skin Color 149
Tattooing and Body Piercing 149
5.2 Accessory Structures of the Skin 150
Hair 150
Skin Glands 153
Nails 155
5.3 Types of Skin 156
5.4 Functions of the Skin 156
Thermoregulation 156
Blood Reservoir 157
Protection 157
Cutaneous Sensations 157
Excretion and Absorption 157
Synthesis of Vitamin D 157
5.5 Maintaining Homeostasis: Skin Wound Healing 158
Epidermal Wound Healing 158
Deep Wound Healing 159
5.6 Development of the Integumentary System 159
5.7 Aging and the Integumentary System 161
6 THE SKELETAL SYSTEM: BONE
TISSUE 169
6.1 Functions of Bone and the Skeletal System 170
6.2 Structure of Bone 170
6.3 Histology of Bone Tissue 171
Compact Bone Tissue 173
Spongy Bone Tissue 173
6.4 Blood and Nerve Supply of Bone 175
6.5 Bone Formation 176
Initial Bone Formation in an Embryo and Fetus 176
Bone Growth during Infancy, Childhood, and
Adolescence 178
Remodeling of Bone 180
Factors Affecting Bone Growth and Bone Remodeling 180
6.6 Fracture and Repair of Bone 182
6.7 Bone’s Role in Calcium Homeostasis 184
6.8 Exercise and Bone Tissue 186
6.9 Aging and Bone Tissue 186
7 THE SKELETAL SYSTEM: THE AXIAL
SKELETON 192
7.1 Divisions of the Skeletal System 193
7.2 Types of Bones 193
7.3 Bone Surface Markings 195
7.4 Skull 196
General Features and
Functions 208
Nasal Septum 208
Orbits 209
Foramina 209
Unique Features of the Skull 210
7.5 Hyoid Bone 213
7.6 Vertebral Column 213
Normal Curves of the Vertebral Column 214
Intervertebral Discs 215
Parts of a Typical Vertebra 215
Regions of the Vertebral Column 216
Age-related Changes in the Vertebral
Column 216

CONTENTS xvii
Hip Replacements 285
Knee Replacements 285
10 MUSCULAR TISSUE 291
10.1 Overview of Muscular Tissue 292
Types of Muscular Tissue 292
Functions of Muscular Tissue 292
Properties of Muscular Tissue 292
10.2 Skeletal Muscle Tissue 293
Connective Tissue Components 293
Nerve and Blood Supply 295
Microscopic Anatomy of a Skeletal
Muscle Fiber 295
Muscle Proteins 299
10.3 Contraction and Relaxation of
Skeletal Muscle Fibers 302
The Sliding Filament Mechanism 302
The Neuromuscular Junction 305
10.4 Muscle Metabolism 309
Production of ATP in Muscle Fibers 309
Muscle Fatigue 310
Oxygen Consumption after Exercise 311
10.5 Control of Muscle Tension 311
Motor Units 311
Twitch Contraction 312
Frequency of Stimulation 312
Motor Unit Recruitment 313
Muscle Tone 313
Isotonic and Isometric Contractions 314
10.6 Types of Skeletal Muscle Fibers 315
Slow Oxidative Fibers 315
Fast Oxidative–Glycolytic Fibers 315
Fast Glycolytic Fibers 315
Distribution and Recruitment of Different Types of Fibers 315
10.7 Exercise and Skeletal Muscle Tissue 317
Effective Stretching 317
Strength Training 317
10.8 Cardiac Muscle Tissue 317
10.9 Smooth Muscle Tissue 318
Microscopic Anatomy of Smooth Muscle 318
Physiology of Smooth Muscle 319
10.10 Regeneration of Muscular Tissue 320
10.11 Development of Muscle 322
10.12 Aging and Muscular Tissue 322
7.7 Thorax 216
8 THE SKELETAL SYSTEM: THE
APPENDICULAR SKELETON 231
8.1 Pectoral (Shoulder) Girdle 232
8.2 Upper Limb (Extremity) 235
8.3 Pelvic (Hip) Girdle 240
8.4 False and True Pelves 242
8.5 Comparison of Female and Male Pelves 245
8.6 Lower Limb (Extremity) 246
8.7 Development of the Skeletal System 253
9 JOINTS 258
9.1 Joint Classifications 259
9.2 Fibrous Joints 259
Sutures 259
Syndesmoses 260
Interosseous Membranes 260
9.3 Cartilaginous Joints 261
Synchondroses 261
Symphyses 261
9.4 Synovial Joints 261
Structure of Synovial Joints 261
Nerve and Blood Supply 263
Bursae and Tendon Sheaths 264
9.5 Types of Movements at Synovial Joints 264
Gliding 264
Angular Movements 264
Rotation 266
Special Movements 267
9.6 Types of Synovial Joints 269
Plane Joints 269
Hinge Joints 269
Pivot Joints 269
Condyloid Joints 269
Saddle Joints 269
Ball-and-Socket Joints 269
9.7 Factors Affecting Contact and Range of Motion
at Synovial Joints 272
9.8 Selected Joints of the Body 272
9.9 Aging and Joints 285
9.10 Arthroplasty 285

xviii CONTENTS
13 THE SPINAL CORD AND SPINAL
NERVES 442
13.1 Spinal Cord Anatomy 443
Protective Structures 443
Vertebral Column 443
External Anatomy of the Spinal Cord 443
Internal Anatomy of the Spinal Cord 447
13.2 Spinal Nerves 449
Connective Tissue Coverings of Spinal Nerves 450
Distribution of Spinal Nerves 450
Dermatomes 460
13.3 Spinal Cord Physiology 460
Sensory and Motor Tracts 460
Reflexes and Reflex Arcs 462
14 THE BRAIN AND CRANIAL
NERVES 473
14.1 Brain Organization, Protection, and Blood Supply 474
Major Parts of the Brain 474
Protective Coverings of the Brain 476
Brain Blood Flow and the Blood–Brain Barrier 477
14.2 Cerebrospinal Fluid 477
Functions of CSF 477
Formation of CSF in the Ventricles 478
Circulation of CSF 478
14.3 The Brain Stem and Reticular Formation 482
Medulla Oblongata 482
Pons 484
Midbrain 484
Reticular Formation 485
14.4 The Cerebellum 487
14.5 The Diencephalon 489
Thalamus 489
Hypothalamus 490
Epithalamus 492
Circumventricular Organs 492
14.6 The Cerebrum 492
Cerebral Cortex 492
Lobes of the Cerebrum 492
Cerebral White Matter 494
Basal Nuclei 494
The Limbic System 495
14.7 Functional Organization of the Cerebral
Cortex 497
Sensory Areas 497
Motor Areas 498
11 THE MUSCULAR SYSTEM 328
11.1 How Skeletal Muscles Produce Movements 329
Muscle Attachment Sites: Origin and Insertion 329
Lever Systems and Leverage 330
Effects of Fascicle Arrangement 330
Coordination among Muscles 331
11.2 How Skeletal Muscles Are Named 333
11.3 Principal Skeletal Muscles 333
12 NERVOUS TISSUE 399
12.1 Overview of the Nervous System 400
Organization of the Nervous System 400
Functions of the Nervous System 400
12.2 Histology of Nervous Tissue 402
Neurons 402
Neuroglia 406
Myelination 408
Collections of Nervous Tissue 409
12.3 Electrical Signals in Neurons 410
Ion Channels 412
Resting Membrane Potential 414
Graded Potentials 416
Generation of Action
Potentials 417
Propagation of Action
Potentials 420
Encoding of Stimulus Intensity 423
Comparison of Electrical Signals
Produced by Excitable Cells 423
12.4 Signal Transmission at Synapses 424
Electrical Synapses 424
Chemical Synapses 425
Excitatory and Inhibitory Postsynaptic Potentials 427
Structure of Neurotransmitter Receptors 427
Removal of Neurotransmitter 427
Spatial and Temporal Summation of Postsynaptic Potentials 429
12.5 Neurotransmitters 432
Small-Molecule Neurotransmitters 432
Neuropeptides 434
12.6 Neural Circuits 435
12.7 Regeneration and Repair of Nervous Tissue 436
Neurogenesis in the CNS 436
Damage and Repair in the PNS 436

CONTENTS xix
16.3 Somatic Sensory Pathways 555
Posterior Column–Medial Lemniscus Pathway to the Cortex 556
Anterolateral Pathway to the Cortex 556
Trigeminothalamic Pathway to the Cortex 557
Mapping the Primary Somatosensory Area 558
Somatic Sensory Pathways to the Cerebellum 559
16.4 Somatic Motor Pathways 560
Organization of Upper Motor Neuron Pathways 561
Roles of the Basal Nuclei 564
Modulation of Movement by the Cerebellum 565
16.5 Integrative Functions of the Cerebrum 566
Wakefulness and Sleep 566
Learning and Memory 567
17 THE SPECIAL SENSES 572
17.1 Olfaction: Sense of Smell 573
Anatomy of Olfactory Receptors 573
Physiology of Olfaction 574
Odor Thresholds and Adaptation 575
The Olfactory Pathway 575
17.2 Gustation: Sense of Taste 576
Anatomy of Taste Buds and Papillae 576
Physiology of Gustation 576
Taste Thresholds and Adaptation 578
The Gustatory Pathway 578
17.3 Vision 579
Electromagnetic Radiation 579
Accessory Structures of the Eye 579
Anatomy of the Eyeball 583
Image Formation 587
Convergence 590
Physiology of Vision 590
The Visual Pathway 592
17.4 Hearing and Equilibrium 595
Anatomy of the Ear 595
The Nature of Sound Waves 598
Physiology of Hearing 601
The Auditory Pathway 602
Physiology of Equilibrium 602
Equilibrium Pathways 606
17.5 Development of the Eyes and Ears 608
Eyes 608
Ears 608
17.6 Aging and the Special Senses 610
Association Areas 498
Hemispheric Lateralization 499
Brain Waves 501
14.8 Cranial Nerves 502
14.9 Development of the Nervous System 515
14.10 Aging and the Nervous System 517
15 THE AUTONOMIC NERVOUS
SYSTEM 523
15.1 Comparison of Somatic and Autonomic Nervous
Systems 524
Somatic Nervous System 524
Autonomic Nervous System 524
Comparison of Somatic and Autonomic Motor Neurons 524
15.2 Anatomy of Autonomic Motor Pathways 526
Anatomical Components 526
Structure of the Sympathetic Division 532
Structure of the Parasympathetic Division 533
Structure of the Enteric Division 534
15.3 ANS Neurotransmitters and Receptors 535
Cholinergic Neurons and Receptors 535
Adrenergic Neurons and Receptors 536
Receptor Agonists and Antagonists 536
15.4 Physiology of the ANS 536
Autonomic Tone 536
Sympathetic Responses 537
Parasympathetic Responses 538
15.5 Integration and Control of Autonomic Functions 540
Autonomic Reflexes 540
Autonomic Control by Higher Centers 541
16 SENSORY, MOTOR, AND INTEGRATIVE
SYSTEMS 546
16.1 Sensation 547
Sensory Modalities 547
The Process of Sensation 547
Sensory Receptors 547
16.2 Somatic Sensations 550
Tactile Sensations 550
Thermal Sensations 551
Pain Sensations 551
Proprioceptive Sensations 553

xx CONTENTS
19 THE CARDIOVASCULAR SYSTEM:
THE BLOOD 661
19.1 Functions and Properties of Blood 662
Functions of Blood 662
Physical Characteristics of Blood 662
Components of Blood 662
19.2 Formation of Blood Cells 665
19.3 Red Blood Cells 668
RBC Anatomy 668
RBC Physiology 668
Homeostatic Control of RBC
Production 670
19.4 White Blood Cells 671
Types of White Blood Cells 671
Functions of White Blood Cells 672
19.5 Platelets 674
19.6 Stem Cell Transplants from Bone Marrow
and Cord Blood 675
19.7 Hemostasis 676
Vascular Spasm 676
Platelet Plug Formation 676
Blood Clotting 677
Role of Vitamin K in Clotting 679
Homeostatic Control of Blood Clotting 679
Intravascular Clotting 680
19.8 Blood Groups and Blood Types 680
ABO Blood Group 681
Transfusions 681
Rh Blood Group 682
Typing and Cross-Matching Blood for Transfusion 682
THE HEART 688
20.1 Anatomy of the Heart 689
Location of the Heart 689
Pericardium 690
Layers of the Heart Wall 691
Chambers of the Heart 692
Myocardial Thickness and Function 695
Fibrous Skeleton of the Heart 696
20.2 Heart Valves and Circulation of Blood 696
Operation of the Atrioventricular Valves 697
Operation of the Semilunar Valves 697
Systemic and Pulmonary Circulations 698
Coronary Circulation 700
18 THE ENDOCRINE SYSTEM 615
18.1 Comparison of Control by the Nervous and
Endocrine Systems 616
18.2 Endocrine Glands 616
18.3 Hormone Activity 617
The Role of Hormone Receptors 617
Circulating and Local Hormones 618
Chemical Classes of Hormones 619
Hormone Transport in the Blood 619
18.4 Mechanisms of Hormone Action 619
Action of Lipid-Soluble Hormones 620
Action of Water-Soluble Hormones 621
Hormone Interactions 622
18.5 Control of Hormone Secretion 622
18.6 Hypothalamus and Pituitary Gland 623
Anterior Pituitary 623
Posterior Pituitary 628
18.7 Thyroid Gland 631
Formation, Storage, and Release of Thyroid Hormones 631
Actions of Thyroid Hormones 633
Control of Thyroid Hormone Secretion 634
Calcitonin 634
18.8 Parathyroid Glands 635
Parathyroid Hormone 635
Control of Secretion of Calcitonin and Parathyroid
Hormone 637
18.9 Adrenal Glands 638
Adrenal Cortex 638
Adrenal Medulla 642
18.10 Pancreatic Islets 642
Cell Types in the Pancreatic Islets 644
Control of Secretion of Glucagon and Insulin 644
18.11 Ovaries and Testes 646
18.12 Pineal Gland and Thymus 646
18.13 Other Endocrine Tissues and Organs, Eicosanoids,
and Growth Factors 647
Hormones from Other Endocrine Tissues and Organs 647
Eicosanoids 647
Growth Factors 648
18.14 The Stress Response 648
The Fight-or-Flight Response 648
The Resistance Reaction 650
Exhaustion 650
Stress and Disease 650
18.15 Development of the Endocrine System 650
18.16 Aging and the Endocrine System 652

CONTENTS xxi
21.6 Shock and Homeostasis 750
Types of Shock 750
Homeostatic Responses to Shock 750
Signs and Symptoms of Shock 752
21.7 Circulatory Routes 752
The Systemic Circulation 752
The Hepatic Portal Circulation 787
The Pulmonary Circulation 788
The Fetal Circulation 788
21.8 Development of Blood Vessels and Blood 791
21.9 Aging and the Cardiovascular System 792
22 THE LYMPHATIC SYSTEM AND
IMMUNITY 799
22.1 Lymphatic System Structure and Function 800
Functions of the Lymphatic System 800
Lymphatic Vessels and Lymph Circulation 800
Lymphatic Organs and Tissues 804
22.2 Development of Lymphatic Tissues 809
22.3 Innate Immunity 810
First Line of Defense: Skin and Mucous Membranes 810
Second Line of Defense: Internal Defenses 811
22.4 Adaptive Immunity 815
Maturation of T Cells and B Cells 815
Types of Adaptive Immunity 816
Clonal Selection: The Principle 816
Antigens and Antigen Receptors 817
Major Histocompatibility Complex Antigens 817
Pathways of Antigen Processing 818
Cytokines 820
22.5 Cell-Mediated Immunity 820
Activation of T Cells 820
Activation and Clonal Selection of Helper T Cells 821
Activation and Clonal Selection of Cytotoxic T Cells 822
Elimination of Invaders 822
Immunological Surveillance 823
22.6 Antibody-Mediated Immunity 824
Activation and Clonal Selection of B Cells 824
Antibodies 825
Immunological Memory 828
22.7 Self-Recognition and Self-Tolerance 829
22.8 Stress and Immunity 831
22.9 Aging and the Immune System 831
20.3 Cardiac Muscle Tissue and the Cardiac Conduction
System 702
Histology of Cardiac Muscle Tissue 702
Autorhythmic Fibers: The Conduction System 704
Action Potential and Contraction of Contractile Fibers 704
ATP Production in Cardiac Muscle 707
Electrocardiogram 707
Correlation of ECG Waves with Atrial and Ventricular Systole 708
20.4 The Cardiac Cycle 710
Pressure and Volume Changes during the Cardiac Cycle 710
Heart Sounds 712
20.5 Cardiac Output 712
Regulation of Stroke Volume 713
Regulation of Heart Rate 714
20.6 Exercise and the Heart 716
20.7 Help for Failing Hearts 717
20.8 Development of the Heart 719
BLOOD VESSELS AND HEMODYNAMICS 729
21.1 Structure and Function of Blood Vessels 730
Basic Structure of a Blood Vessel 730
Arteries 732
Anastomoses 733
Arterioles 733
Capillaries 733
Venules 735
Veins 736
Blood Distribution 737
21.2 Capillary Exchange 738
Diffusion 738
Transcytosis 739
Bulk Flow: Filtration and Reabsorption 739
21.3 Hemodynamics: Factors Affecting Blood Flow 741
Blood Pressure 741
Vascular Resistance 742
Venous Return 742
Velocity of Blood Flow 743
21.4 Control of Blood Pressure and Blood Flow 744
Role of the Cardiovascular Center 744
Neural Regulation of Blood Pressure 745
Hormonal Regulation of Blood Pressure 747
Autoregulation of Blood Flow 747
21.5 Checking Circulation 748
Pulse 748
Measuring Blood Pressure 748

xxii CONTENTS
Mechanical and Chemical
Digestion in the Mouth 898
24.6 Pharynx 898
24.7 Esophagus 899
Histology of the Esophagus 899
Physiology of the Esophagus 899
24.8 Deglutition 899
24.9 Stomach 901
Anatomy of the Stomach 901
Histology of the Stomach 903
Mechanical and Chemical Digestion in
the Stomach 904
24.10 Pancreas 906
Anatomy of the Pancreas 906
Histology of the Pancreas 907
Composition and Functions of Pancreatic Juice 907
24.11 Liver and Gallbladder 909
Anatomy of the Liver and Gallbladder 909
Histology of the Liver and Gallbladder 909
Blood Supply of the Liver 912
Functions of the Liver and Gallbladder 912
24.12 Small Intestine 913
Anatomy of the Small Intestine 913
Histology of the Small Intestine 914
Role of Intestinal Juice and Brush-Border Enzymes 918
Mechanical Digestion in the Small Intestine 918
Chemical Digestion in the Small Intestine 918
Absorption in the Small Intestine 919
24.13 Large Intestine 924
Anatomy of the Large Intestine 924
Histology of the Large Intestine 926
Mechanical Digestion in the Large Intestine 927
Chemical Digestion in the Large Intestine 928
Absorption and Feces Formation in the Large Intestine 928
The Defecation Reflex 928
24.14 Phases of Digestion 930
Cephalic Phase 930
Gastric Phase 930
Intestinal Phase 931
Other Hormones of the Digestive System 932
24.15 Development of the Digestive System 932
24.16 Aging and the Digestive System 932
25 METABOLISM AND NUTRITION 940
25.1 Metabolic Reactions 941
Coupling of Catabolism and Anabolism by ATP 941
23 THE RESPIRATORY SYSTEM 840
23.1 Respiratory System Anatomy 841
Nose 841
Pharynx 845
Larynx 845
The Structures of Voice Production 847
Trachea 849
Bronchi 850
Lungs 851
Patency of the Respiratory System 856
23.2 Pulmonary Ventilation 856
Pressure Changes during Pulmonary Ventilation 857
Other Factors Affecting Pulmonary Ventilation 860
Breathing Patterns and Modified Respiratory Movements 861
23.3 Lung Volumes and Capacities 862
23.4 Exchange of Oxygen and Carbon Dioxide 863
Gas Laws: Dalton’s Law and Henry’s Law 863
External and Internal Respiration 864
23.5 Transport of Oxygen and Carbon Dioxide 866
Oxygen Transport 867
Carbon Dioxide Transport 870
Summary of Gas Exchange and Transport in Lungs
and Tissues 871
23.6 Control of Breathing 872
Respiratory Center 872
Regulation of the Respiratory Center 873
23.7 Exercise and the Respiratory System 876
23.8 Development of the Respiratory System 877
23.9 Aging and the Respiratory System 878
24 THE DIGESTIVE SYSTEM 886
24.1 Overview of the Digestive System 887
24.2 Layers of the GI Tract 888
Mucosa 889
Submucosa 889
Muscularis 889
Serosa 889
24.3 Neural Innervation of the GI Tract 889
Enteric Nervous System 889
Autonomic Nervous System 890
Gastrointestinal Reflex Pathways 890
24.4 Peritoneum 890
24.5 Mouth 893
Salivary Glands 894
Tongue 895
Teeth 896

CONTENTS xxiii
26.3 Overview of Renal Physiology 991
26.4 Glomerular Filtration 992
The Filtration Membrane 992
Net Filtration Pressure 993
Glomerular Filtration Rate 994
26.5 Tubular Reabsorption and Tubular Secretion 995
Principles of Tubular Reabsorption and Secretion 995
Reabsorption and Secretion in the Proximal Convoluted
Tubule 998
Reabsorption in the Nephron Loop 1000
Reabsorption in the Early Distal Convoluted Tubule 1001
Reabsorption and Secretion in the Late Distal Convoluted
Tubule and Collecting Duct 1001
Homeostatic Regulation of Tubular Reabsorption and
Tubular Secretion 1001
26.6 Production of Dilute and Concentrated Urine 1003
Formation of Dilute Urine 1004
Formation of Concentrated Urine 1004
26.7 Evaluation of Kidney Function 1008
Urinalysis 1008
Blood Tests 1008
Renal Plasma Clearance 1009
26.8 Urine Transportation, Storage, and Elimination 1010
Ureters 1010
Urinary Bladder 1011
Urethra 1013
26.9 Waste Management in Other Body Systems 1014
26.10 Development of the Urinary System 1015
26.11 Aging and the Urinary System 1016
27 FLUID, ELECTROLYTE, AND
ACID–BASE HOMEOSTASIS 1023
27.1 Fluid Compartments and Fluid Homeostasis 1024
Sources of Body Water Gain and Loss 1025
Regulation of Body Water Gain 1025
Regulation of Water and Solute Loss 1025
Movement of Water between Body Fluid
Compartments 1027
27.2 Electrolytes in Body Fluids 1028
Concentrations of Electrolytes in Body Fluids 1028
Sodium 1029
Chloride 1030
Potassium 1030
Bicarbonate 1030
Calcium 1030
Phosphate 1030
Magnesium 1031
25.2 Energy Transfer 942
Oxidation–Reduction Reactions 942
Mechanisms of ATP Generation 942
25.3 Carbohydrate Metabolism 943
The Fate of Glucose 943
Glucose Movement into Cells 943
Glucose Catabolism 943
Glucose Anabolism 950
25.4 Lipid Metabolism 953
Transport of Lipids by Lipoproteins 953
Sources and Significance of Blood Cholesterol 954
The Fate of Lipids 954
Triglyceride Storage 954
Lipid Catabolism: Lipolysis 954
Lipid Anabolism: Lipogenesis 955
25.5 Protein Metabolism 956
The Fate of Proteins 956
Protein Catabolism 956
Protein Anabolism 956
25.6 Key Molecules at Metabolic Crossroads 958
The Role of Glucose 6-Phosphate 959
The Role of Pyruvic Acid 959
The Role of Acetyl Coenzyme A 959
25.7 Metabolic Adaptations 959
Metabolism during the Absorptive State 960
Metabolism during the Postabsorptive State 962
Metabolism during Fasting and Starvation 963
25.8 Heat and Energy Balance 964
Metabolic Rate 964
Body Temperature Homeostasis 964
Energy Homeostasis and Regulation of Food Intake 967
25.9 Nutrition 968
Guidelines for Healthy Eating 969
Minerals 970
Vitamins 970
26 THE URINARY SYSTEM 979
26.1 Overview of Kidney Functions 981
26.2 Anatomy and Histology of
the Kidneys 981
External Anatomy of the
Kidneys 981
Internal Anatomy of the
Kidneys 983
Blood and Nerve Supply of the
Kidneys 984
The Nephron 984

xxiv CONTENTS
Third Week of Development 1096
Fourth Week of
Development 1102
Fifth through Eighth Weeks of
Development 1104
29.2 Fetal Period 1105
29.3 Teratogens 1107
Chemicals and Drugs 1108
Cigarette Smoking 1108
Irradiation 1108
29.4 Prenatal Diagnostic Tests 1108
Fetal Ultrasonography 1108
Amniocentesis 1108
Chorionic Villi Sampling 1109
Noninvasive Prenatal Tests 1109
29.5 Maternal Changes during Pregnancy 1110
Hormones of Pregnancy 1110
Changes during Pregnancy 1111
29.6 Exercise and Pregnancy 1113
29.7 Labor 1113
29.8 Adjustments of the Infant at Birth 1115
Respiratory Adjustments 1115
Cardiovascular Adjustments 1115
29.9 The Physiology of Lactation 1116
29.10 Inheritance 1117
Genotype and Phenotype 1118
Variations on Dominant–Recessive Inheritance 1119
Autosomes, Sex Chromosomes, and Sex
Determination 1120
Sex-Linked Inheritance 1122
APPENDIX A: MEASUREMENTS A-1
APPENDIX B: PERIODIC TABLE B-3
APPENDIX C: NORMAL VALUES FOR SELECTED BLOOD TESTS C-4
APPENDIX D: NORMAL VALUES FOR SELECTED URINE TESTS D-6
APPENDIX E: ANSWERS E-8
GLOSSARY G-1 CREDITS C-1 INDEX I-1
27.3 Acid–Base Balance 1031
The Actions of Buffer Systems 1033
Exhalation of Carbon Dioxide 1034
Kidney Excretion of H⫹
1035
Acid–Base Imbalances 1036
27.4 Aging and Fluid, Electrolyte, and Acid–Base
Homeostasis 1037
28 THE REPRODUCTIVE SYSTEMS 1041
28.1 Male Reproductive System 1042
Scrotum 1042
Testes 1043
Reproductive System Ducts in Males 1048
Accessory Sex Glands 1051
Semen 1052
Penis 1052
28.2 Female Reproductive System 1054
Ovaries 1054
Uterine Tubes 1061
Uterus 1062
Vagina 1065
Vulva 1065
Perineum 1067
Mammary Glands 1068
28.3 The Female Reproductive Cycle 1069
Homeostatic Control of the Female Reproductive
Cycle 1069
Phases of the Female Reproductive Cycle 1070
28.4 Birth Control Methods and Abortion 1074
Birth Control Methods 1074
Abortion 1077
28.5 Development of the Reproductive Systems 1077
28.6 Aging and the Reproductive Systems 1079
29 DEVELOPMENT AND
INHERITANCE 1089
29.1 Embryonic Period 1090
First Week of Development 1090
Second Week of Development 1094

CLINICAL CONNECTIONS AND DISORDERS
CHAPTER 1
Noninvasive Diagnostic Techniques 5
Autopsy 8
Diagnosis of Disease 12
CHAPTER 2
Harmful and Beneficial Effects of
Radiation 30
Free Radicals and Antioxidants 31
Artificial Sweeteners 44
Fatty Acids in Health and Disease 48
DNA Fingerprinting 54
CHAPTER 3
Medical Uses of Isotonic, Hypertonic,
and Hypotonic Solutions 68
Digitalis Increases Ca2⫹
in Heart
Muscle Cells 70
Viruses and Receptor-Mediated
Endocytosis 72
Phagocytosis and Microbes 72
Cilia and Smoking 77
Smooth ER and Drug Tolerance 80
Tay-Sachs Disease 82
Proteasomes and Disease 83
Genomics 85
Mitotic Spindle and Cancer 93
Disorders: Homeostatic Imbalances 99
CHAPTER 4
Biopsy 107
Basement Membranes and Disease 111
Papanicolaou Test 118
Chondroitin Sulfate, Glucosamine,
and Joint Disease 123
Liposuction and Cryolipolysis 126
Tissue Engineering 130
Adhesions 137
CHAPTER 5
Skin Grafts 146
Psoriasis 147
Stretch Marks 148
Tension Lines and Surgery 148
Albinism and Vitiligo 149
Skin Color as a Diagnostic Clue 149
Hair Removal 150
Chemotherapy and Hair Loss 152
Hair and Hormones 152
Acne 153
Impacted Cerumen 155
Transdermal Drug Administration 157
Sun Damage, Sunscreens,
and Sunblocks 162
CHAPTER 6
Remodeling and Orthodontics 180
Paget’s Disease 180
Hormonal Abnormalities That Affect
Height 182
Treatments for Fractures 183
CHAPTER 7
Black Eye 193
Cleft Palate and Cleft Lip 206
Temporomandibular Joint Syndrome 207
Deviated Nasal Septum 208
Sinusitis 212
Caudal Anesthesia 223
Rib Fractures, Dislocations,
and Separations 216
CHAPTER 8
Fractured Clavicle 233
Boxer’s Fracture 239
Pelvimetry 244
Patellofemoral Stress Syndrome 248
Bone Grafting 249
Fractures of the Metatarsals 250
Flatfoot and Clawfoot 252
CHAPTER 9
Autologous Chondrocyte
Implantation 262
Torn Cartilage and Arthroscopy 263
Bursitis 264
Rotator Cuff Injury, Dislocated and
Separated Shoulder, and Torn Glenoid
Labrum 278
Tennis Elbow, Little-League Elbow,
and Dislocation of the Radial
Head 279
Knee Injuries 285
CHAPTER 10
Fibromyalgia 293
Muscular Hypertrophy, Fibrosis,
and Atrophy 295
Rigor Mortis 305
Electromyography 307
Creatine Supplementation 310
Aerobic Training versus Strength
Training 313
Hypotonia and Hypertonia 314
Anabolic Steroids 317
CHAPTER 11
Intramuscular Injections 331
Benefits of Stretching 333
Bell’s Palsy 337
Strabismus 340
Gravity and the Mandible 342
Intubation during Anesthesia 345
Dysphagia 347
Inguinal Hernia 351
Injury of Levator Ani and Urinary Stress
Incontinence 357
Impingement Syndrome 363
Rotator Cuff Injury 364
Golfer’s Elbow 369
Carpal Tunnel Syndrome 375
Back Injuries and Heavy Lifting 378
Groin Pull 381
Pulled Hamstrings 385
Shin Splint Syndrome 388
Disorders: Homeostatic
Imbalances 396
CHAPTER 12
Neurotoxins and Local Anesthetics 422
Strychnine Poisoning 431
Modifying the Effects of
Neurotransmitters 434
xxv

CHAPTER 13
Spinal Tap 443
Injuries to the Phrenic Nerves 452
Injuries to Nerves Emerging from the
Brachial Plexus 453
Injuries to the Lumbar Plexus 457
Injury to the Sciatic Nerve 458
Reflexes and Diagnosis 467
CHAPTER 14
Breaching the Blood–Brain Barrier 477
Hydrocephalus 479
Injury of the Medulla 484
Ataxia 488
Aphasia 499
Brain Injuries 502
Dental Anesthesia 502
Anosmia 503
Anopia 504
Strabismus, Ptosis, and Diplopia 506
Trigeminal Neuralgia 507
Bell’s Palsy 508
Vertigo, Ataxia, Nystagmus, and Tinnitus 509
Dysphagia, Aptyalia, and Ageusia 510
Vagal Neuropathy, Dysphagia,
and Tachycardia 511
Paralysis of the Sternocleidomastoid
and Trapezius Muscles 512
Dysarthria and Dysphagia 513
CHAPTER 15
Horner’s Syndrome 533
CHAPTER 16
Phantom Limb Sensation 551
Analgesia: Relief from Pain 553
Syphilis 560
Paralysis 561
Amyotrophic Lateral Sclerosis 563
Disorders of the Basal Nuclei 565
Sleep Disorders 567
Amnesia 568
CHAPTER 17
Hyposmia 576
Taste Aversion 579
Detached Retina 586
Age-Related Macular Disease 588
Presbyopia 589
LASIK 589
Color Blindness and Night Blindness 592
Loud Sounds and Hair Cell Damage 598
Cochlear Implants 602
Motion Sickness 608
CHAPTER 18
Blocking Hormone Receptors 618
Administering Hormones 619
Diabetogenic Effect of hGH 626
Oxytocin and Childbirth 630
Congenital Adrenal Hyperplasia 641
Seasonal Affective Disorder and
Jet Lag 647
Nonsteroidal Anti-inflammatory Drugs 648
Posttraumatic Stress Disorder 650
CHAPTER 19
Withdrawing Blood 662
Bone Marrow Examination 667
Medical Uses of Hemopoietic Growth
Factors 667
Iron Overload and Tissue Damage 670
Reticulocyte Count 670
Blood Doping 671
Complete Blood Count 674
Aspirin and Thrombolytic Agents 680
Hemolytic Disease of the Newborn 682
Anticoagulants 683
CHAPTER 20
Cardiopulmonary Resuscitation 691
Pericarditis 691
Myocarditis and Endocarditis 691
Heart Valve Disorders 699
Myocardial Ischemia and Infarction 702
Regeneration of Heart Cells 702
Artificial Pacemakers 704
Heart Murmurs 712
CHAPTER 21
Angiogenesis and Disease 730
Varicose Veins 738
Edema 740
Syncope 743
Carotid Sinus Massage and Carotid Sinus
Syncope 746
CHAPTER 22
Metastasis through Lymphatic
Vessels 808
Ruptured Spleen 808
Tonsillitis 808
Microbial Evasion of Phagocytosis 812
Abscesses and Ulcers 814
Cytokine Therapy 820
Graft Rejection and Tissue Typing 824
Monoclonal Antibodies 826
Cancer Immunology 830
CHAPTER 23
Rhinoplasty 842
Tonsillectomy 844
Laryngitis and Cancer of the Larynx 849
Tracheotomy and Intubation 849
Pneumothorax and Hemothorax 852
Coryza, Seasonal Influenza, and H1N1
Influenza 856
Respiratory Distress Syndrome 860
Hyperbaric Oxygenation 864
Carbon Monoxide Poisoning 870
Hypoxia 875
Effects of Smoking on the Respiratory
System 677
CHAPTER 24
Peritonitis 892
Mumps 895
Root Canal Therapy 896
xxvi

Gastroesophageal Reflux Disease 901
Pylorospasm and Pyloric Stenosis 903
Vomiting 906
Pancreatitis and Pancreatic Cancer 908
Jaundice 912
Liver Function Tests 912
Gallstones 913
Lactose Intolerance 919
Absorption of Alcohol 923
Appendicitis 925
Polyps in the Colon 927
Occult Blood 928
Dietary Fiber 928
Disorders: Homeostatic
Imbalances 934
CHAPTER 25
Carbohydrate Loading 952
Ketosis 956
Phenylketonuria 957
Hypothermia 967
Emotional Eating 968
Vitamin and Mineral Supplements 970
CHAPTER 26
Nephroptosis (Floating Kidney) 983
Loss of Plasma Proteins in Urine Causes
Edema 994
Glucosuria 998
Diuretics 1008
Dialysis 1010
Urinary Incontinence 1013
CHAPTER 27
Enemas and Fluid Balance 1028
Indicators of Na⫹
Imbalance 1030
Diagnosis of Acid–Base
Imbalances 1037
CHAPTER 28
Cryptorchidism 1045
Circumcision 1053
Premature Ejaculation 1054
Ovarian Cysts 1060
Uterine Prolapse 1063
Hysterectomy 1065
Episiotomy 1067
Breast Augmentation and Reduction 1069
Fibrocystic Disease of the Breasts 1069
Female Athlete Triad: Disordered
Eating, Amenorrhea, and Premature
Osteoporosis 1073
CHAPTER 29
Stem Cell Research and Therapeutic
Cloning 1092
Ectopic Pregnancy 1093
Anencephaly 1098
Placenta Previa 1102
Early Pregnancy Tests 1110
Pregnancy-Induced Hypertension 1113
Dystocia and Cesarean Section 1115
Premature Infants 1116
xxvii
Chapter 5 Integumentary System 163
Chapter 8 Skeletal System 255
Chapter 11 Muscular System 395
Chapter 15 Nervous System 542
Chapter 18 Endocrine System 653
Chapter 21 Cardiovascular System 793
Chapter 22 Lymphatic System and
Immunity 832
Chapter 23 Respiratory System 879
Chapter 24 Digestive System 933
Chapter 26 Urinary System 1017
Chapter 28 Reproductive Systems 1081
FOCUS ON HOMEOSTASIS

Did you ever wonder why an autopsy is performed
An Introduction
to the Human Body
The human body and homeostasis
Humans have many ways to maintain homeostasis, the state of relative stability of the body’s
internal environment. Disruptions to homeostasis often set in motion corrective cycles, called
feedback systems, that help restore the conditions needed for health and life.
Our fascinating journey through the human body begins with an overview of the meanings of anatomy and physiology,
followed by a discussion of the organization of the human body and the properties that it shares with all living things.
Next, you will discover how the body regulates its own internal environment; this unceasing process, called homeostasis,
is a major theme in every chapter of this book. Finally, we introduce the basic vocabulary that will help you speak about
the body in a way that is understood by scientists and health-care professionals alike.
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2 CHAPTER 1 • AN INTRODUCTION TO THE HUMAN BODY
1.1 Anatomy and Physiology
Defined
O B J E C T I V E
• Define anatomy and physiology, and name several
branches of these sciences.
Two branches of science—anatomy and physiology—provide the
foundation for understanding the body’s parts and functions.
Anatomy (a-NAT-o
ˉ-mē; ana- ⫽ up; -tomy ⫽ process of cutting) is
the science of body structures and the relationships among them.
It was first studied by dissection (dis-SEK-shun; dis- ⫽ apart;
-section ⫽ act of cutting), the careful cutting apart of body struc-
tures to study their relationships. Today, a variety of imaging
techniques (see Table 1.3) also contribute to the advancement of
anatomical knowledge. Whereas anatomy deals with structures of
the body, physiology (fiz⬘-ē-OL-o
ˉ-jē; physio- ⫽ nature; -logy ⫽
study of) is the science of body functions—how the body parts work.
Table 1.1 describes several branches of anatomy and physiology.
Because structure and function are so closely related, you will
learn about the human body by studying its anatomy and physiol-
ogy together. The structure of a part of the body often reflects its
functions. For example, the bones of the skull join tightly to form
a rigid case that protects the brain. The bones of the fingers are
more loosely joined to allow a variety of movements. The walls of
the air sacs in the lungs are very thin, permitting rapid movement
of inhaled oxygen into the blood.
C H E C K P O I N T
1. What body function might a respiratory therapist strive
to improve? What structures are involved?
2. Give your own example of how the structure of a part of
the body is related to its function.
1.2 Levels of Structural
Organization and
Body Systems
O B J E C T I V E S
• Describe the body’s six levels of structural organization.
• List the 11 systems of the human body, representative
organs present in each, and their general functions.
TABLE 1.3
BRANCH OF ANATOMY STUDY OF BRANCH OF PHYSIOLOGY STUDY OF
Embryology The first eight weeks of
(em⬘-brē-OL-ō-jē; development after fertilization
embry- ⫽ embryo; of a human egg.
-logy ⫽ study of)
Developmental biology The complete development of an
individual from fertilization to
death.
Cell biology Cellular structure and functions.
Histology Microscopic structure of tissues.
(his-TOL-ō -jē; hist- ⫽ tissue)
Gross anatomy Structures that can be examined
without a microscope.
Systemic anatomy Structure of specific systems of
the body such as the nervous or
respiratory systems.
Regional anatomy Specific regions of the body such
as the head or chest.
Surface anatomy Surface markings of the body
to understand internal anatomy
through visualization and
palpation (gentle touch).
Imaging anatomy Body structures that can be
visualized with techniques such
as x-rays, MRI, and CT scans.
Pathological anatomy Structural changes (gross to
(path⬘-ō-LOJ-i-kal; microscopic) associated with
path- ⫽ disease) disease.
Neurophysiology Functional properties of nerve
(NOOR-ō-fiz-ē-ol⬘-ō-jē; cells.
neuro- ⫽ nerve)
Endocrinology Hormones (chemical regulators in
(en⬘-dō-kri-NOL-ō-jē; the blood) and how they control
endo- ⫽ within; -crin ⫽ secretion) body functions.
Cardiovascular physiology Functions of the heart and blood
(kar-dē-ō-VAS-kū-lar; vessels.
cardi- ⫽ heart;
vascular ⫽ blood vessels)
Immunology The body’s defenses against
(im⬘-ū-NOL-ō-jē; disease-causing agents.
immun- ⫽ not susceptible)
Respiratory physiology Functions of the air passageways
(RES-pi-ra-tōr-ē; and lungs.
respira- ⫽ to breathe)
Renal physiology Functions of the kidneys.
(RĒ-nal; ren- ⫽ kidney)
Exercise physiology Changes in cell and organ functions
due to muscular activity.
Pathophysiology Functional changes associated
(Path-ō-fiz-ē-ol⬘-ō-jē) with disease and aging.
TABLE 1.1
Selected Branches of Anatomy and Physiology

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1.2 LEVELS OF STRUCTURAL ORGANIZATION AND BODY SYSTEMS 3
The levels of organization of a language—letters, words, sentences,
paragraphs, and so on—can be compared to the levels of organiza-
tion of the human body. Your exploration of the human body will
extend from atoms and molecules to the whole person. From the
smallest to the largest, six levels of organization will help you to
understand anatomy and physiology: the chemical, cellular, tissue,
organ, system, and organismal levels of organization (Figure 1.1).
1 Chemical level. This very basic level can be compared to the
letters of the alphabet and includes atoms, the smallest units
of matter that participate in chemical reactions, and molecules,
two or more atoms joined together. Certain atoms, such as
carbon (C), hydrogen (H), oxygen (O), nitrogen (N), phos-
phorus (P), calcium (Ca), and sulfur (S), are essential for
maintaining life. Two familiar molecules found in the body
are deoxyribonucleic acid (DNA), the genetic material passed
from one generation to the next, and glucose, commonly
known as blood sugar. Chapters 2 and 25 focus on the chemi-
cal level of organization.
Figure 1.1 Levels of structural organization in the human body.
The levels of structural organization are chemical, cellular, tissue, organ, system, and organismal.
Which level of structural organization is composed of two or more different types of tissues that work together to perform a
specific function?
6
3
4
5
1 CHEMICAL LEVEL
Atoms (C, H, O, N, P)
2 CELLULAR LEVEL
Molecule (DNA)
Smooth muscle cell
Smooth muscle tissue
ORGANISMAL LEVEL
SYSTEM LEVEL
Mouth
Liver
Gallbladder
Large intestine
Esophagus
Small intestine
Pancreas
(behind stomach)
Stomach
Digestive system
Stomach
Epithelial tissue
Epithelial
and
connective
tissues
ORGAN LEVEL
TISSUE LEVEL
Smooth muscle
tissue layers
Pharynx
Salivary glands

brain. Figure 1.1 shows how several tissues make up the stom-
ach. The stomach’s outer covering is a layer of epithelial
tissue and connective tissue that reduces friction when the
stomach moves and rubs against other organs. Underneath are
three layers of a type of muscular tissue called smooth muscle
tissue, which contracts to churn and mix food and then push it
into the next digestive organ, the small intestine. The inner-
most lining is an epithelial tissue layer that produces fluid and
chemicals responsible for digestion in the stomach.
5 System level. A system (or chapter in our language analogy)
consists of related organs (paragraphs) with a common func-
tion. An example of the system level, also called the organ-
system level, is the digestive system, which breaks down and
absorbs food. Its organs include the mouth, salivary glands,
pharynx (throat), esophagus (food tube), stomach, small in-
testine, large intestine, liver, gallbladder, and pancreas.
Sometimes an organ is part of more than one system. The
pancreas, for example, is part of both the digestive system
and the hormone-producing endocrine system.
6 Organismal level. An organism (OR-ga-nizm), any living
individual, can be compared to a book in our analogy. All the
parts of the human body functioning together constitute the
total organism.
In the chapters that follow, you will study the anatomy and
physiology of the body systems. Table 1.2 lists the components
and introduces the functions of these systems. You will also dis-
cover that all body systems influence one another. As you study
each of the body systems in more detail, you will discover how
2 Cellular level. Molecules combine to form cells, the basic
structural and functional units of an organism that are com-
posed of chemicals. Just as words are the smallest elements
of language that make sense, cells are the smallest living
units in the human body. Among the many kinds of cells in
your body are muscle cells, nerve cells, and epithelial cells.
Figure 1.1 shows a smooth muscle cell, one of the three types
of muscle cells in the body. The cellular level of organization
is the focus of Chapter 3.
3 Tissue level. Tissues are groups of cells and the materials
surrounding them that work together to perform a particular
function, similar to the way words are put together to form
sentences. There are just four basic types of tissues in your
body: epithelial tissue, connective tissue, muscular tissue, and
nervous tissue. Epithelial tissue covers body surfaces, lines
hollow organs and cavities, and forms glands. Connective tis-
sue connects, supports, and protects body organs while distrib-
uting blood vessels to other tissues. Muscular tissue contracts
to make body parts move and generates heat. Nervous tissue
carries information from one part of the body to another through
nerve impulses. Chapter 4 describes the tissue level of organi-
zation in greater detail. Shown in Figure 1.1 is smooth muscle
tissue, which consists of tightly packed smooth muscle cells.
4 Organ level. At the organ level different types of tissues are
joined together. Similar to the relationship between sentences
and paragraphs, organs are structures that are composed of
two or more different types of tissues; they have specific func-
tions and usually have recognizable shapes. Examples of
organs are the stomach, skin, bones, heart, liver, lungs, and
TABLE 1.2
The Eleven Systems of the Human Body
INTEGUMENTARY SYSTEM (CHAPTER 5) SKELETAL SYSTEM (CHAPTERS 6–9)
Components: Skin and associated
structures, such as hair,
fingernails and toenails, sweat
glands, and oil glands.
Functions: Protects body; helps
regulate body temperature;
eliminates some wastes; helps
make vitamin D; detects
sensations such as touch, pain,
warmth, and cold; stores fat and
provides insulation.
Components: Bones and joints
of the body and their associated
cartilages.
Functions: Supports and
protects body; provides surface
area for muscle attachments;
aids body movements; houses
cells that produce blood cells;
stores minerals and lipids (fats).
Hair
Skin and
associated
glands
Fingernails
Toenails
T
T
Bone
Cartilage
Joint

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1.3 CHARACTERISTICS OF THE LIVING HUMAN ORGANISM 5
C H E C K P O I N T
3. Define the following terms: atom, molecule, cell, tissue,
organ, system, and organism.
4. At what levels of organization would an exercise
physiologist study the human body? (Hint: Refer to
Table 1.1.)
5. Referring to Table 1.2, which body systems help eliminate
wastes?
1.3 Characteristics of the Living
Human Organism
O B J E C T I V E S
• Define the important life processes of the human body.
Basic Life Processes
Certain processes distinguish organisms, or living things, from
nonliving things. Following are the six most important life pro-
cesses of the human body:
1. Metabolism (me-TAB-o
ˉ-lizm) is the sum of all chemical
processes that occur in the body. One phase of metabolism is
catabolism (ka-TAB-o
ˉ-lizm; catabol- ⫽ throwing down; -ism ⫽
a condition), the breakdown of complex chemical substances
into simpler components. The other phase of metabolism is
anabolism (a-NAB-o
ˉ-lizm; anabol- ⫽ a raising up), the build-
ing up of complex chemical substances from smaller, simpler
components. For example, digestive processes catabolize (split)
they work together to maintain health, provide protection from
disease, and allow for reproduction of the human species.
MUSCULAR SYSTEM (CHAPTERS 10, 11) NERVOUS SYSTEM (CHAPTERS 12–17)
Components: Brain, spinal cord,
nerves, and special sense organs, such
as eyes and ears.
Functions: Generates action potentials
(nerve impulses) to regulate body
activities; detects changes in body’s
internal and external environments,
interprets changes, and responds by
causing muscular contractions or
glandular secretions.
Components: Specifically, skeletal
muscle tissue—muscle usually
attached to bones (other muscle tissues
include smooth and cardiac).
Functions: Participates in body
movements, such as walking;
maintains posture; produces heat.
Skeletal
muscle
Tendon
T
T
Nerve
Spinal
cord
Brain
TABLE 1.2 CONTINUES
Health-care professionals and students of anatomy and physiol-
ogy commonly use several noninvasive diagnostic techniques to
assess certain aspects of body structure and function. A noninvasive
diagnostic technique is one that does not involve insertion of an
instrument or device through the skin or a body opening. In inspec-
tion, the examiner observes the body for any changes that deviate
from normal. For example, a physician may examine the mouth cavity
for evidence of disease. Following inspection, one or more additional
techniques may be employed. In palpation (pal-PĀ-shun; palp- ⫽ gently
touching) the examiner feels body surfaces with the hands. An exam-
ple is palpating the abdomen to detect enlarged or tender internal
organs or abnormal masses. In auscultation (aws-kul-TĀ-shun; auscult-
⫽ listening) the examiner listens to body sounds to evaluate the func-
tioning of certain organs, often using a stethoscope to amplify the
sounds. An example is auscultation of the lungs during breathing to
check for crackling sounds associated with abnormal fluid accumula-
tion. In percussion (pur-KUSH-un; percus- ⫽ beat through) the exam-
iner taps on the body surface with the fingertips and listens to the
resulting sound. Hollow cavities or spaces produce a different sound
than solid organs. For example, percussion may reveal the abnormal
presence of fluid in the lungs or air in the intestines. It may also pro-
vide information about the size, consistency, and position of an under-
lying structure. An understanding of anatomy is important for the
effective application of most of these diagnostic techniques. •
CLINICAL CONNECTION |
Noninvasive
Diagnostic Techniques

TABLE 1.2 CONTINUED
The Eleven Systems of the Human Body
ENDOCRINE SYSTEM (CHAPTER 18) CARDIOVASCULAR SYSTEM (CHAPTERS 19–21)
Components: Hormone-producing glands (pineal gland, hypothalamus,
pituitary gland, thymus, thyroid gland, parathyroid glands, adrenal
glands, pancreas, ovaries, and testes) and hormone-producing cells in
several other organs.
Functions: Regulates body activities by releasing hormones (chemical
messengers transported in blood from endocrine gland or tissue to target organ).
Components: Blood, heart, and blood vessels.
Functions: Heart pumps blood through blood vessels; blood carries oxygen
and nutrients to cells and carbon dioxide and wastes away from cells and helps
regulate acid–base balance, temperature, and water content of body fluids;
blood components help defend against disease and repair damaged blood
vessels.
LYMPHATIC SYSTEM AND IMMUNITY (CHAPTER 22)
Components: Lymphatic fluid and vessels; spleen, thymus, lymph nodes,
and tonsils; cells that carry out immune responses (B cells, T cells, and
others).
Functions: Returns proteins and fluid to blood; carries lipids from
gastrointestinal tract to blood; contains sites of maturation and proliferation
of B cells and T cells that protect against disease-causing microbes.
RESPIRATORY SYSTEM (CHAPTER 23)
Components: Lungs and air passageways such as the pharynx (throat),
larynx (voice box), trachea (windpipe), and bronchial tubes leading into and
out of lungs.
Functions: Transfers oxygen from inhaled air to blood and carbon dioxide
from blood to exhaled air; helps regulate acid–base balance of body fluids; air
flowing out of lungs through vocal cords produces sounds.
O
Ovary
(f
female)
P ncreas
an
Thyroid
y
nd
glan
T stis
es
T
T
ale)
(ma
renal
Adr
nd
glan
Pineal gland
Pituitary gland
Hypothalamus
Thyroid
gland
Pos
sterior
v
view
Parathyroid
glands
Blood
vessels:
Artery
Vein
Heart
Pharyngeal
tonsil
Palatine
tonsil
Lingual
tonsil
L mphatic
y
v ssel
es
Lymph
node
Red bone
marrow
pleen
Sp
h
Thymus
horacic
Th
uct
du
Lung
g
Bron
nchus
Nasal cavity
Oral cavity
r
Larynx
Pharyn
nx
Lary
ynx
Phar
rynx
Trach
hea

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1.3 CHARACTERISTICS OF THE LIVING HUMAN ORGANISM 7
DIGESTIVE SYSTEM (CHAPTER 24) URINARY SYSTEM (CHAPTER 26)
Components: Kidneys, ureters,
urinary bladder, and urethra.
Functions: Produces, stores, and
eliminates urine; eliminates
wastes and regulates volume and
chemical composition of blood;
helps maintain the acid–base
balance of body fluids; maintains
body’s mineral balance; helps
regulate production of red blood
cells.
Components: Organs of
gastrointestinal tract,
a long tube that
includes the mouth,
pharynx (throat),
esophagus (food tube),
stomach, small and
large intestines, and
anus; also includes
accessory organs that
assist in digestive
processes, such as
salivary glands, liver,
gallbladder, and
pancreas.
Functions: Achieves
physical and chemical
breakdown of food;
absorbs nutrients;
eliminates solid wastes.
REPRODUCTIVE SYSTEMS (CHAPTER 28)
Components: Gonads (testes in males and ovaries
in females) and associated organs (uterine tubes or
fallopian tubes, uterus, vagina, and mammary
glands in females and epididymis, ductus or
vas deferens, seminal vesicles, prostate, and
penis in males).
Functions: Gonads produce gametes (sperm
or oocytes) that unite to form a new organism;
gonads also release hormones that regulate
reproduction and other body processes;
associated organs transport and store
gametes; mammary glands produce milk.
Pancreas
(behind
stomach)
Stomach
Liver
Esophagus
s
Salivary
gland th
Mou
Anus
Gallbladder
Large
intestine
r
Pharynx
Rectum
Small
intestine
Kidney
Ureter
Urethra
Urinary
bladder
Ovary
Ovary
y
Vagina
V
V
Mammary
gland
Uterine
tube
Uterine
tube
Uterus
Ute
erus
Vag
gina
V
V
Prostate
Ductus
(vas)
deferens
Seminal
vesicle
Epididymis
Penis
Prostate
Seminal
vesicle
Ductus
(vas)
deferens
Testis
T
T
Penis
Testis
T
T
proteins in food into amino acids. These amino acids are then
used to anabolize (build) new proteins that make up body struc-
tures such as muscles and bones.
2. Responsiveness is the body’s ability to detect and respond to
changes. For example, an increase in body temperature during
a fever represents a change in the internal environment (within
the body), and turning your head toward the sound of squealing
brakes is a response to a change in the external environment
(outside the body) to prepare the body for a potential threat.
Different cells in the body respond to environmental changes
in characteristic ways. Nerve cells respond by generating elec-
trical signals known as nerve impulses (action potentials).
Muscle cells respond by contracting, which generates force to
move body parts.
3. Movement includes motion of the whole body, individual
organs, single cells, and even tiny structures inside cells. For

C H E C K P O I N T
6. List the six most important life processes in the human
body.
1.4 Homeostasis
O B J E C T I V E S
• Define homeostasis.
• Describe the components of a feedback system.
• Contrast the operation of negative and positive feedback
systems.
• Explain how homeostatic imbalances are related to
disorders.
Homeostasis (ho
ˉ⬘-mē-o
ˉ-STA
ˉ-sis; homeo- ⫽ sameness; -stasis ⫽
standing still) is the condition of equilibrium (balance) in the
body’s internal environment due to the constant interaction of
the body’s many regulatory processes. Homeostasis is a dynamic
condition. In response to changing conditions, the body’s equi-
librium can shift among points in a narrow range that is compat-
ible with maintaining life. For example, the level of glucose in
blood normally stays between 70 and 110 milligrams of glucose
per 100 milliliters of blood.* Each structure, from the cellular
level to the system level, contributes in some way to keeping the
internal environment of the body within normal limits.
Homeostasis and Body Fluids
An important aspect of homeostasis is maintaining the volume
and composition of body fluids, dilute, watery solutions contain-
ing dissolved chemicals that are found inside cells as well as
surrounding them. The fluid within cells is intracellular fluid
(intra- ⫽ inside), abbreviated ICF. The fluid outside body cells
is extracellular fluid (ECF) (extra- ⫽ outside). The ECF that fills
the narrow spaces between cells of tissues is known as interstitial
fluid (in⬘-ter-STISH-al; inter- ⫽ between). As you progress with
your studies, you will learn that the ECF differs depending on
where it occurs in the body: ECF within blood vessels is termed
blood plasma, within lymphatic vessels it is called lymph, in and
around the brain and spinal cord it is known as cerebrospinal
fluid, in joints it is referred to as synovial fluid, and the ECF of
the eyes is called aqueous humor and vitreous body.
The proper functioning of body cells depends on precise regu-
lation of the composition of the interstitial fluid surrounding
them. Because of this, interstitial fluid is often called the body’s
internal environment. The composition of interstitial fluid changes
as substances move back and forth between it and blood plasma.
Such exchange of materials occurs across the thin walls of the
smallest blood vessels in the body, the blood capillaries. This
movement in both directions across capillary walls provides
needed materials, such as glucose, oxygen, ions, and so on, to
tissue cells. It also removes wastes, such as carbon dioxide, from
interstitial fluid.
example, the coordinated action of leg muscles moves your
whole body from one place to another when you walk or run.
After you eat a meal that contains fats, your gallbladder con-
tracts and releases bile into the gastrointestinal tract to help
digest them. When a body tissue is damaged or infected, certain
white blood cells move from the bloodstream into the affected
tissue to help clean up and repair the area. Inside the cell,
various parts, such as secretory vesicles (see Figure 3.20),
move from one position to another to carry out their functions.
4. Growth is an increase in body size that results from an increase
in the size of existing cells, an increase in the number of cells,
or both. In addition, a tissue sometimes increases in size be-
cause the amount of material between cells increases. In a grow-
ing bone, for example, mineral deposits accumulate between
bone cells, causing the bone to grow in length and width.
5. Differentiation (dif⬘-er-en-shē-A
ˉ-shun) is the development of
a cell from an unspecialized to a specialized state. Such pre-
cursor cells, which can divide and give rise to cells that un-
dergo differentiation, are known as stem cells. As you will see
later in the text, each type of cell in the body has a specialized
structure or function that differs from that of its precursor
(ancestor) cells. For example, red blood cells and several types
of white blood cells all arise from the same unspecialized pre-
cursor cells in red bone marrow. Also through differentiation,
a single fertilized human egg (ovum) develops into an embryo,
and then into a fetus, an infant, a child, and finally an adult.
6. Reproduction (rē-pro
ˉ-DUK-shun) refers either to (1) the for-
mation of new cells for tissue growth, repair, or replacement,
or (2) the production of a new individual. The formation of
new cells occurs through cell division. The production of a
new individual occurs through the fertilization of an ovum by
a sperm cell to form a zygote, followed by repeated cell divi-
sions and the differentiation of these cells.
When any one of the life processes ceases to occur properly,
the result is death of cells and tissues, which may lead to death of
the organism. Clinically, loss of the heartbeat, absence of sponta-
neous breathing, and loss of brain functions indicate death in the
human body.
An autopsy (AW-top-sē ⫽ seeing with one's own eyes) or
necropsy is a postmortem (after death) examination of the
body and dissection of its internal organs to confirm or deter-
mine the cause of death. An autopsy can uncover the existence of
diseases not detected during life, determine the extent of injuries,
and explain how those injuries may have contributed to a person's
death. It also may provide more information about a disease, assist
in the accumulation of statistical data, and educate health-care
students. Moreover, an autopsy can reveal conditions that may affect
offspring or siblings (such as congenital heart defects). Sometimes an
autopsy is legally required, such as during a criminal investigation. It
may also be useful in resolving disputes between beneficiaries and
insurance companies about the cause of death. •
CLINICAL CONNECTION | Autopsy
*Appendix A describes metric measurements.

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1.4 HOMEOSTASIS 9
temperature example, the brain acts as the control center, re-
ceiving nerve impulses from the skin receptors and generating
nerve impulses as output.
3. An effector (e-FEK-tor) is a body structure that receives out-
put from the control center and produces a response or effect
that changes the controlled condition. Nearly every organ or
tissue in the body can behave as an effector. When your body
temperature drops sharply, your brain (control center) sends
nerve impulses (output) to your skeletal muscles (effectors).
The result is shivering, which generates heat and raises your
body temperature.
A group of receptors and effectors communicating with their
control center forms a feedback system that can regulate a con-
trolled condition in the body’s internal environment. In a feed-
back system, the response of the system “feeds back” information
Control of Homeostasis
Homeostasis in the human body is continually being disturbed.
Some disruptions come from the external environment in the
form of physical insults such as the intense heat of a hot summer
day or a lack of enough oxygen for that two-mile run. Other dis-
ruptions originate in the internal environment, such as a blood
glucose level that falls too low when you skip breakfast. Homeo-
static imbalances may also occur due to psychological stresses in
our social environment—the demands of work and school, for
example. In most cases the disruption of homeostasis is mild
and temporary, and the responses of body cells quickly restore
balance in the internal environment. However, in some cases the
disruption of homeostasis may be intense and prolonged, as in
poisoning, overexposure to temperature extremes, severe infection,
or major surgery.
Fortunately, the body has many regulating systems that can
usually bring the internal environment back into balance. Most
often, the nervous system and the endocrine system, working to-
gether or independently, provide the needed corrective measures.
The nervous system regulates homeostasis by sending electrical
signals known as nerve impulses (action potentials) to organs that
can counteract changes from the balanced state. The endocrine
system includes many glands that secrete messenger molecules
called hormones into the blood. Nerve impulses typically cause
rapid changes, but hormones usually work more slowly. Both
means of regulation, however, work toward the same end, usually
through negative feedback systems.
Feedback Systems
The body can regulate its internal environment through many
feedback systems. A feedback system or feedback loop is a cycle
of events in which the status of a body condition is monitored,
evaluated, changed, remonitored, reevaluated, and so on. Each
monitored variable, such as body temperature, blood pressure, or
blood glucose level, is termed a controlled condition. Any disrup-
tion that changes a controlled condition is called a stimulus. A
feedback system includes three basic components: a receptor, a
control center, and an effector (Figure 1.2).
1. A receptor is a body structure that monitors changes in a con-
trolled condition and sends input to a control center. This path-
way is called an afferent pathway (AF-er-ent; af- ⫽ toward;
-ferrent ⫽ carried), since the information flows toward the
control center. Typically, the input is in the form of nerve im-
pulses or chemical signals. For example, certain nerve endings
in the skin sense temperature and can detect changes, such as
a dramatic drop in temperature.
2. A control center in the body, for example, the brain, sets the
range of values within which a controlled condition should be
maintained (set point), evaluates the input it receives from re-
ceptors, and generates output commands when they are needed.
Output from the control center typically occurs as nerve im-
pulses, or hormones or other chemical signals. This pathway is
called an efferent pathway (EF-er-ent; ef- ⫽ away from), since
the information flows away from the control center. In our skin
Figure 1.2 Operation of a feedback system.
The three basic components of a feedback system are
the receptor, control center, and effector.
disrupts homeostasis by
increasing or decreasing a
that is
monitored by
that send nerve impulses
or chemical signals to a
that receives the input
and provides nerve
impulses or chemical
signals to
that bring about
a change or
Return to
homeostasis when
the response brings
the controlled
condition back to
normal
STIMULUS
RESPONSE that alters
the controlled condition
RECEPTORS
CONTROL CENTER
EFFECTORS
Input
Output
What is the main difference between negative and
positive feedback systems?

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